Pethidine‐associated seizure in a healthy adolescent receiving pethidine for postoperative pain control

Abstract

A healthy 17-year-old male received standard intermittent doses of pethidine via a patient-controlled analgesia (PCA) pump for management of postoperative pain control. Twenty-three h postoperatively he developed a brief self-limited seizure. Both plasma pethidine and norpethidine were elevated in the range associated with clinical manifestations of central nervous system excitation. No other risk factors for CNS toxicity were identified. This method allowed frequent self-dosing of pethidine at short time intervals and rapid accumulation of pethidine and norpethidine. The routine use of pethidine via PCA even for a brief postoperative analgesia should be reconsidered.

Meperidine Induced Seizure in a Patient With Lyme Borreliosis

“…The serum meperidine concentration was measured 1418 ng.ml -1 while the therapeutic serum meperidine ranges were between 200 and 800 ng.ml -1 . One month later, the patient received again meperidine via PCA, but this time the patient received only a total of 491 mg meperidine without any sign of central nervous system excitation [8]. This patient experienced a seizure after standard therapeutic doses of meperidine PCA and had no previously identified risk factors for the development of meperidine induced seizures.…”

L’ajout d’adrénaline à la mépéridine péridurale thoracique n’améliore pas l’analgésie à la suite d’une thoracotomie

“…While these results failed to demonstrate a role of adrenaline, they may support a role for PCEA meperidine in postoperative analgesia. The postoperative use of meperidine has come under increased scrutiny following a number of case reports of seizures [21][22][23] related to the accumulation of a toxic meperidine metabolite. Meperidine is metabolized through n-demethylation to normeperidine a compound possessing both analgesic and neurotoxic properties.…”

“…21 Systemic normeperidine levels noted in patients reported with seizures ranged from 0.375-3.2 µg·mL -1 . [21][22][23] Concern over meperidine-related neurotoxicity led the Agency for Health Care Policy Research to state "meperidine should be reserved for very brief courses in otherwise healthy patients who have demonstrated an unusual reaction…during treatment with other opioids." B Similarly the National Pharmaceutical Council in cooperation with the Joint Commission on Accreditation of Healthcare Organizations suggested limiting the use of meperidine to less than 48 hr or less than 600 mg in 24 hr.…”

Postoperative pain management in obstetric anesthesia–new challenges and solutions

“…65 Although one study showed that there is no significant difference in pain scores and side effects of PCA using morphine, fentanyl, or meperidine, the reports of seizures that are associated with the use of meperidine has made the medication a less desirable drug of choice. 66,67 Morphine PCA should also be avoided in patients with renal failure because of the increased risk of accumulation of the active metabolite, morphine-6-glucuronide. The results of a meta-analysis of 15 randomized control trials indicated that PCA in general generated higher patient satisfaction and better pain relief, with no increase in side effects, when compared with oral or intermittent IV opioid administration.…”